Citation Nr: 18154800 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-35 201A DATE: November 30, 2018 ORDER Entitlement to special monthly compensation (SMC) based on the regular need for aid and attendance is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDING OF FACT The Veteran is shown to need regular aid and attendance due to service-connected disabilities. CONCLUSION OF LAW The criteria for special monthly compensation based on the Veteran being in need regular aid and attendance have been met. 38 U.S.C. §§ 1114, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.352. REASONS AND BASES FOR FINDING AND CONCLUSION 1. Entitlement to special monthly compensation (SMC) on the basis of need of care of another person for aid and attendance and/ or housebound benefits The Veteran asserts entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance. “Special monthly compensation” is payable to a person who is permanently bedridden or so helpless as a result of service-connected disability that he is in need of the regular aid and attendance of another person. 38 U.S.C. § 1114 (l); 38 C.F.R. § 3.350 (b). The following will be accorded consideration in determining the need for regular aid and attendance: Inability of a claimant to dress or undress him or herself, or to keep him or herself ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.); inability of a claimant to feed him or herself through loss of coordination of the upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect a claimant from the hazards or dangers incident to his or her daily environment. 38 C.F.R. § 3.352 (a). It is not required that all of the disabling conditions enumerated in 38 C.F.R. § 3.352 (a) be found to exist before a favorable rating may be made. The particular personal functions which the veteran is unable to perform should be considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need regular aid and attendance, not that there is a constant need. See Turco v. Brown, 9 Vet. App. 222 (1996). The critical question to be determined in this case is whether the Veteran’s service-connected disabilities result in the need for regular aid and attendance of another person because of helplessness due to mental and/or physical impairment. Service connection is in effect for posttraumatic stress disorder (PTSD), bilateral shoulder rotator cuff tear with synovitis, lumbar disc disease, radiculopathy of the left upper and lower extremities, bilateral knee patellofemoral syndrome with medial meniscus tear and degenerative joint disease, cervical spine disc disease, plantar fasciitis, tinnitus, carpal tunnel syndrome left wrist, left elbow strain, left wrist sprain, hearing loss, allergic rhinitis, and erectile dysfunction. His combined service-connected rating is 100 percent, effective May 28, 2010; and entitlement to a SMC(k)(1) also has been established from May 28, 2010 (for loss of use of a creative organ); and SMC(s)(1) for PTSD rated as 100 percent disabling and additional service-connected disabilities independently ratable at 60 percent or more from December 16, 2014. The Board finds that the criteria for special monthly compensation based on the need for aid and attendance due to service-connected disabilities have been met. A December 2014 VA aid and attendance examination notes that the Veteran’s PTSD, bilateral patellofemoral syndrome, cervical disc disease, lumbar spine, and bilateral rotator cuff injuries prevent the Veteran from preparing his own meals due to limited range of motion and unsteadiness in upper and lower extremities. The report further noted that the Veteran needed assistance in bath and tending to other hygiene needs due to high risk for falls secondary to unsteadiness. It was noted that the Veteran’s bilateral shoulder range of motion restriction limited the Veteran’s ability to perform toileting hygiene. Additionally, it was noted that the Veteran required verbal reminders to take medications at the appropriate times secondary to confusion and memory deficits related to PTSD. A March 2015 VA examination report notes that the Veteran had impairments that affected the Veteran’s ability to protect himself from the daily environment, including difficulty with his knees and ankles, as well as his back. It also was noted that the Veteran required assistance bathing. It was noted that he was generally able to attend to his bathroom needs unassisted. He occasionally would fall but was generally able to protect himself from the hazards of daily living. The Veteran underwent separate VA examinations for his service-connected shoulder, plantar fasciitis, back, knees, elbows, wrist, elbow, cervical spine, hearing loss, and allergic rhinitis disabilities in April 2015, which noted that each disability separately did not result in the need for aid and assistance. In April 2016, VA treatment records show the Veteran had an in-home assessment for the caregiver program. The report noted that the Veteran’s wife assisted him with getting in and out of the shower/tub and also assisted with toweling due to limited motion of his left arm. The Veteran and his wife also reported that the Veteran needed assistance with dressing due to limitations in his shoulders and raising his arms above shoulder level. In addition, he reported limited finger dexterity for buttons. He reportedly needed assistance with preparing meals. The Veteran reported that he was semi-dependent with regard to basic activities of daily living. The preponderance of the evidence shows that the Veteran needs aid and attendance of another person, and the aid and attendance examinations note that his service-connected disabilities are factors causing his impairment. While the March 2015 VA examination report noted that the Veteran could protect himself from hazards of daily living, that report also noted that the Veteran had impairments that affected the Veteran’s ability to protect himself from the daily environment, including difficulty with his knees and ankles, as well as his back, which on its face appears to be contradictory conclusions. The April 2015 VA examinations, which demonstrated that separately his service-connected disabilities did not render him in need of aid and attendance, do not address whether his service-connected disabilities as a whole do so. These reports also did not address his service-connected PTSD. The other medical evidence of record, including the December 2014 aid and attendance examination and the March 2016 VA caregiver assessment show that the Veteran has trouble dressing and getting in and out of the tub due to his service-connected physical disabilities, as well as trouble remembering his medication due to his service-connected psychiatric disability. All doubt is resolved in the Veteran’s favor that his service-connected disabilities render him in need of regular aid and attendance of another person. Thus, the criteria for special monthly compensation based on aid and attendance are shown to have been met. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Sarah B. Richmond